Proposal for classifying the acute emetogenicity of cancer chemotherapy.

Hesketh, Paul J.; Kris, Mark G.; Grunberg, Steven M.; Beck, Thomas M.; Hainsworth, John D.; Harker, Graydon; Aapro, Matti; Gandara, D.; Lindley, Celeste

doi:10.1200/jco.1997.15.1.103

Cited by 544 publications

(412 citation statements)

References 53 publications

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“…17 Although current guidelines for the prevention of delayed nausea and vomiting in patients receiving moderately emetogenic chemotherapy consistently recommend the use of a 5-HTreceptor antagonist plus dexamethasone for prevention of acute symptoms, they continue to recommend several alternative regimens for prevention of delayed symptoms, reflecting the uncertainty of panel members and the weakness of published evidence. 3,4,18 Even though these guidelines may outline optimum treatment for control of vomiting, these drugs do not seem to be adequate for control of delayed nausea.…”

Section: Discussionmentioning

confidence: 99%

5-hydroxytryptamine-receptor antagonists versus prochlorperazine for control of delayed nausea caused by doxorubicin: a URCC CCOP randomised controlled trial

Hickok¹,

Roscoe²,

Morrow³

et al. 2005

The Lancet Oncology

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Section: Discussionmentioning

confidence: 99%

5-hydroxytryptamine-receptor antagonists versus prochlorperazine for control of delayed nausea caused by doxorubicin: a URCC CCOP randomised controlled trial

Hickok¹,

Roscoe²,

Morrow³

et al. 2005

The Lancet Oncology

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“…The emetic potential of the drugs in the chemotherapy regimen, which in turn depends on their doses and schedules resulted in them being classified into groups of those with minimal, low, moderate or high risk of causing emesis if left untreated [18]. The emetic potential of combinations of drugs were more problematic to classify, due to the limited data available.…”

Section: Prognostic Factorsmentioning

confidence: 99%

Antiemetic research: future directions

Olver

Molassiotis

Aapro

et al. 2010

Support Care Cancer

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Purpose and methods As a part of reviewing the Multinational Association of Supportive Care in Cancer (MASCC) antiemetic guidelines in Perugia in 2009, an expert group identified directions for future antiemetic research. Results and conclusions In future trials, the prediction of nausea and vomiting may combine algorithms based on observed prognostic factors relating to the patient and the anticancer therapy, the identification of the genes that code for receptors, and pharmacogenetic studies of the metabolism of drugs. Design issues for future trials include standardising the emetic stimulus across studies and finding the minimum tolerated effective dose and schedule of an antiemetic. Also control of delayed emesis is not independent of the control of acute emesis. The full range of side effects and the impact on global quality of life scores should be part of the routine assessment of an antiemetic. With current high rates of control of acute vomiting, future trials will need to consider new primary endpoints such as nausea, a complex symptom, where improvement is needed. Economic endpoints should be incorporated to ascertain the cost benefit of antiemetic prophylaxis, taking into account the impact of nausea on work capacity. New antiemetic drugs may be targeted at different receptors, such as opioid, cannabinoid and peptide YY receptors. New research is needed into determining the extent of corticosteroid use. The emetic potential of a range of newer cytotoxics particularly when used in combinations and different scheduling, such as prolonged oral dosing of cytotoxics and use of targeted therapies, are all areas in need of research. More antiemetic studies are needed in niche areas such as in patients receiving high dose chemotherapy, radiation therapy or combined modality therapy. Further evidence of the efficacy of newer antiemetic agents is required in children.

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“…The emetogenic potential of a chemotherapeutic regimen depends on a number of factors, including the chosen cytotoxic agent(s), the dose given, and the administration schedule (Table 1) [7,15,16]. Cisplatin is one of the most highly emetogenic agents, with doses of 50 mg/m 2 or more inducing nausea and vomiting within 24 hours in more than 90% of patients not administered antiemetic prophylaxis.…”

Section: Risk Factors For the Development Of Acute Nausea And Vomitingmentioning

confidence: 99%

“…The emetogenicity of radiotherapy is mainly Adapted with permission from Clin J Oncol Nurs 1999;3:113-119 [7]. Based on information from Bilgrami and Fallon [15] and Hesketh et al [16].…”

Section: Risk Factors For the Development Of Acute Nausea And Vomitingmentioning

confidence: 99%

Chemotherapy-Induced Nausea and Vomiting: The Importance of Acute Antiemetic Control

Schnell¹

2003

The Oncologist

186

167

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Nausea and vomiting are two of the most feared side effects of cancer chemotherapy and radiotherapy. Chemotherapy-induced nausea and vomiting can be broadly categorized as acute (occurring within 24 hours of therapy), delayed (persisting for 6-7 days after therapy), or anticipatory (occurring prior to chemotherapy administration). Breakthrough and refractory nausea and vomiting describe the symptoms of uncontrolled emesis. Evidence suggests that good control of nausea and vomiting during the acute period correlates with the control of delayed emesis. Conversely, protection failure during the first 24 hours has a high predictive value for delayed emesis in the same cycle.The 5-HT 3 -receptor antagonists, regarded as the 'gold standard' in antiemetic therapy, are the first-line treatment for moderately and highly emetogenic chemotherapy and radiotherapy regimens in adults and children. Evidence suggests that the 5-HT 3 -receptor antagonists administered in combination with corticosteroids afford the best protection from symptoms of acute emesis and, by extrapolation, the most effective prevention of delayed emesis.Antiemetic therapeutic guidelines stress that the goal of therapy is to prevent cytostatic-induced nausea and vomiting. Therefore, the prophylactic use of the most effective antiemetic regimen-taking into consideration the emetogenicity of the chemotherapy and individual patient characteristics-must be adhered to in order to prevent acute, delayed, and anticipatory nausea and vomiting.

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Proposal for classifying the acute emetogenicity of cancer chemotherapy.

Abstract: The proposed classification schema provides a practical means to determine the emetogenic potential of individual chemotherapy agents and combination regimens during the 24 hours after administration. This system can serve as a framework for the development of antiemetic guidelines.

Cited by 544 publications

References 53 publications

5-hydroxytryptamine-receptor antagonists versus prochlorperazine for control of delayed nausea caused by doxorubicin: a URCC CCOP randomised controlled trial

5-hydroxytryptamine-receptor antagonists versus prochlorperazine for control of delayed nausea caused by doxorubicin: a URCC CCOP randomised controlled trial

Antiemetic research: future directions

Chemotherapy-Induced Nausea and Vomiting: The Importance of Acute Antiemetic Control

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